Table 1.
Projects | Hospitals, No.a | Hospital Size, No. of Beds | Baseline Data (May 2015–October 2016) | Intervention Data (November 2016–April 2018) | Key Interventions by IDt and Local ASP Pharmacistsb |
---|---|---|---|---|---|
Medication use evaluations | |||||
Meropenem | 5 | 18–90 | 13 DOT/1000 DP | 9 DOT/1000 DP (P = .03)c | • Education on local resistance using local antibiograms, ASP committee meetings, and guideline review |
Vancomycin | 2 | 28–56 | 75 DOT/1000 DP | 53 DOT/1000 DP (P < .01) | • Education on SSTI, UTI, CAP guidelines |
• Implementation of MRSA nasal swabs for CAP | |||||
Piperacillin-tazobactam | 1 | 25 | 59 DOT/1000 DP | 85 DOT/1000 DP (P = .09)d | • Education on appendicitis guideline |
• Initiation of 48-h timeout | |||||
Fluoroquinolone | 1 | 14 | 147 DOT/1000 DP | 82 DOT/1000 DP (P < .01) | • Education on management of ASB, and appropriate treatment of UTI and CAP |
Process improvement projects | |||||
Allergy assessment and surgical prophylaxis | 2 | 26–30 | 30%–50% inappropriate clindamycin use | <5% inappropriate use | • Nurse/physician education on allergies |
• Prospective pharmacist order review | |||||
Pharmacist-led RDT protocol for bacteremia | 1 | 148 | Median 33 h to antibiotic de-escalatione with RDT alone | Median 14 h to antibiotic de-escalatione when real-time pharmacist intervention added to RDT (P = .01) | • Developed RDT protocol and trained local pharmacists |
• 24/7 real-time intervention by local pharmacists on RDT results/bacteremia | |||||
Pharmacist review of finalized ED cultures | 4 | 26–90 | ED cultures not being reviewed in timely/standardized manner postdischarge | 121 recommendations made to optimize antibiotics | • Trained local pharmacists and developed guideline for common ED conditions |
19 documented as good catch/avoided safety event | • IDt pharmacist available for questions | ||||
Surgical prophylaxis audit | 1 | 25 | 14% suboptimal antibiotic timing/ documentation | Reduced to 7% | • Physician education |
• Active pharmacist surveillance |
Abbreviations: ASB, asymptomatic bacteriuria; ASP, antibiotic stewardship program; ED, emergency department; CAP, community-acquired pneumonia; DOT/1000 DP, days of therapy per 1000 days present; IDt, infectious diseases telehealth; MRSA, methicillin-resistant Staphylococcus aureus; RDT, rapid diagnostic test; SSTI, skin and soft tissue infection; UTI, urinary tract infection.
aMultiple hospitals could participate in each project. Hospitals that completed multiple projects appear more than once.
bPatient charts were reviewed for all quality improvement projects to assess appropriateness, and physicians were given feedback on their prescribing.
cMean antibiotic usage (DOT/1000 DP) over 18-month intervention period compared to mean usage over 18-month baseline period.
dAn increase in patients admitted with infectious diseases conditions requiring piperacillin-tazobactam may have led to increased usage.
eTime to de-escalation compared using Kaplan-Meier survival analysis with log-rank test.